Please login to the form below

Not currently logged in

Public health and market access

Understanding and aligning with the public health agenda shouldn't be overlooked by pharma in getting products to market

Doctor holding a no smoking signPublic health in the UK is often overlooked by the NHS and therefore the pharmaceutical industry. With the exception of a few areas such as vaccination, if you mention support for the public health agenda, the response among industry professionals can be muted; while a belief that 'public health is not central to my brand' is commonly held. This may be true for some, but understanding and aligning with the public health agenda can be highly relevant to others.

Given the UK government's Health and Social Care Bill, and more specifically  its public health ambitions as laid out in Healthy Lives, Healthy People; our strategy for public health England, maybe the time has come to reconsider the opportunities for optimal market access that the public health platform might afford.

Public health and payers
In today's environment, a treatment's perceived value is critical when negotiating with payers. While pricing and reimbursement, patient access schemes and comparative effectiveness remain pivotal, they are by no means the only key considerations when building and communicating the value of a brand. Maximising the value of any intervention in the real world will improve patient outcomes and drive patient access. If this is the case, it makes sense then that we need to broaden our approach to include all aspects of patient education and care that support best practice.

In addressing the challenges posed in demonstrating the value of any treatment or intervention, payers should be considered as 'investors in health', not merely as 'guardians of the budget'. Local payer engagement strategies should consider the added value a company can offer beyond the provision of a treatment alone. Increasingly referred to as Medicines Plus, this could include support for service development initiatives, change management programmes, commissioning, market research, patient access, coalition building, or patient concordance and persistence programmes to name but a few. All of these ideas can improve patient outcomes while maximising the true potential that a treatment can offer in the real world.

In this paradigm, optimal access can be achieved through the provision of treatment and programmes that improve patient outcomes, ideally in partnership with key stakeholders.

A real world example of this approach is smoking cessation. Indeed, smoking cessation is a great example of how pharmacological interventions, company sponsored support programmes, local education programmes, coupled to local services such as NHS smoking cessation clinics can work in synergy to support a patient's attempt to quit.  While there is more that can be done to improve quit rates, the principles behind an integrated approach would be highly applicable to the management of other diseases that fall within the public health agenda.

With this thinking firmly in mind, it is clear that the Government's ambitions for public health in England could provide a rich stream of potential opportunities for forward thinking pharma companies with the relevant portfolio. Indeed, supporting the construction and delivery of patient focussed programmes that improve both treatment outcomes and resource utilisation, provides a win-win for payers, the industry, patients and the communities in which they live.

Healthy Lives, Healthy People
Healthy Lives, Healthy People; Our strategy for public health in England lays out a radical shift in the way public health challenges are tackled. Its aim is to protect the population from serious health threats; helping people live longer, healthier and more fulfilling lives; and improving the health of the poorest fastest.

Healthy Lives will be delivered through the assessment and delivery of outcomes focussed programmes and initiatives, which in turn will empower local leadership to deliver more.

The reasons for change are compelling:
  • Working age ill health costs £100 billion a year
  • Future biggest threats to health, such as diabetes and obesity, are related to public health
  • Smoking is the single biggest preventable cause of early death and illness and costs the NHS £2.7bn a year, while £150m is spent on prevention
  • Estimates of burden of mental ill health range from 15 to 23 per cent of total health burden, estimated to costs £77.4bn in 2003.
  • Inequality is an independent factor for poor public health independent of socio economic status

The strategy recognises that the current system and approach is not up to the task and the one size fits all solutions are ineffective when the public health challenges vary from one community to the next. Tacking the wider social determinants of health in a coherent approach, as opposed to tackling individual risk factors alone, is the most effective way forward. At a practical level, an example is addressing some of the root causes of depression, such as debt problems, or local anti-social behaviour, in conjunction with appropriate treatment and non-pharmacological interventions.

Importantly, Healthy Lives recognises the significant value new technologies can offer, technology that coupled to new partnerships with innovative thinking can be adopted for the benefit of individuals.

Furthermore, the paper recognises the importance of innovative, integrated and dynamic approaches with plans developed and delivered locally. Aspects of local market access initiatives that would no doubt be warmly welcomed by many payers.

Public health and the EU
Of course, the focus on public health goes far beyond the UK alone and citizen's health and safety is a core EU priority. EU health policy attempts to give everyone the right to the same high standards of healthcare and access to quality healthcare.

At the heart of their public health policies is an ambition to prevent illness and diseases, promote healthier lifestyles and protect people from threats such as pandemics. While the organisation and delivery of healthcare is the responsibility of EU nation states, the EU strive to add value to this delivery and bring countries together to address challenges that are applicable to them all.

In addition, there is no doubt that the EU facilitates excellence exchange between countries. The UK's Health and Wellbeing Boards is perhaps an example of this. The boards, that will remove divisions between the NHS and local authorities and give communities greater say in the services needed to provide care for local people, are not dissimilar to those programmes set up by local councils in Sweden some years ago.

The opportunity for the industry
The pharmaceutical industry has a great track record in terms of innovation, planning, integration and partnerships, coupled to significant expertise in communication. All skills that can be deployed to support payers meet their professional goals.

Disappointingly though, Healthy Lives and the Command Paper that has followed this, fails to adequately reflect the contribution the industry has made to public health.  Arguably, this omission was more than an oversight; it could well be a fundamental lack of appreciation of the role of pharmacological interventions in public health. Stroke prevention is a very obvious case in hand.

This omission of the industry as a critical partner should not deter industry from seeking to be a partner. So what can the industry do?

The first step is to challenge personal assumptions that public health is all about “don't drink, don't smoke, don't have unsafe sex, eat five a day and exercise”. Public health offers smart companies with the right products with the opportunity to differentiate, while supporting and maintaining patient access to their treatments.

The second step is to identify if there are synergies with the public health agenda. Mental health, drug treatment, infectious disease control, chronic pain management, stroke prevention and associated areas such as cholesterol and diabetes management, smoking cessation and obesity management, all fall firmly within the public health agenda.

The third step is to read and understand the implications of Healthy Lives. Not only will this help identify potential opportunities, but the paper itself is a treasure trove on information and references on how to better engage patients, their family and the communities within which they live. 

Case study: Thinking out of the box, bpha resident health and wellbeing programme
Bedfordshire Pilgrims Housing Association (bpha) is one of the country's leading providers of affordable housing. The English Housing Association sector provides two million homes for five million residents, many of who have complex health needs. With full knowledge of this fact, bpha is delivering an integrated health and wellbeing programme targeted at their residents.

John Cross, CEO, bpha, said: “Increasingly, health priorities will be addressed at a local level, supported by local organisations who understand their community's needs. The Housing Association sector can play a critical role in supporting the health and wellbeing of our tenants, a passion we have in common with the healthcare industry. The established relationships and communication channels we have with our tenants means that we make an ideal partner for targeted health intervention programmes”.

Nick James, MD, Trio Media, who has partnered with bpha in the delivery of their programme said: “The significant changes in the way that health services will be commissioned and provided, means that the industry is going to need to start to think very differently in terms of those they partner with. While on the face of it, public health may not be an obvious route to ensuring the industry's voice is heard, my experience of the industry and my work with bpha demonstrates that it is.”

In an ever changing world, where it's hard enough keeping up with healthcare reform and the payer agenda, thinking about public health may appear to be a luxury the busy executive can ill afford. However, if we collectively think of payers as investors in their communities' health, we can start to explore how the public health agenda – and the critical role that Medicines Plus can play – can create highly relevant and patient focussed platforms that demonstrate the value of the industry partner and not just the drug.

Distant cousins?  You tell me.

The Authors
Carsten Edwards, managing partner, Ogilvy Healthworld Market Access: and Matt DeGruchy, CEO, Ogilvy Healthworld:

Have your say in the comment box below.

5th December 2011


Featured jobs

Subscribe to our email news alerts


Add my company

OncoSec is a clinical-stage biotechnology company focused on developing cytokine-based intratumoral immunotherapies to stimulate the body's immune system to target...

Latest intelligence

The ALS patient journey
Nick Goldup is the Director of Care Improvement at the Motor Neuron Disease Association (MNDA). Here, he offers his insights into the journey for patients with ALS and explores the...
Equipping your medical affairs teams with solutions to navigate the healthcare landscape
Dr Tyler Ray, OPEN Health Medical Communications...
Protein degraders
Can protein degraders unlock ‘undruggable’ drug targets?
Exploring a new and exciting area of small-molecule drug discovery...